[Gas exchange function of the lungs in patients with type 1 diabetes mellitus].

AIM: To investigate diffuse capacity and static pulmonary volumes in type 1 diabetics. MATERIAL AND METHODS: We investigated 141 young (66 females) patients with long-standing type 1 diabetes mellitus (IDDM) (mean age 26.2, 6.2 years, mean duration of endocrinopathy 12.6, 7.3 years) in comparison to 36 age-, sex-, weight- and height-matched healthy controls (C). The diabetic patients were divided into 4 groups: 1) 46 diabetic patients without microvascular complications (DP1), 2) 48 diabetic patients with debut late complication (DP2), 3) 34 diabetic patients with severe late complications (DP3), 4) 13 diabetic patients with end-stage renal failure (nephropathy stage 5) who were not yet on dialysis (DP4). Spirometry measurements before and after bronchodilator administration were performed, TL(CO) was measured in sitting position by the single-breath (TL(COsb)) and steady-state (TL(COss) methods, TL(COsb) corrected by alveolar volume (KCO = TL(COsb)/VA), single breath helium dilution lung volumes were done. RESULTS: There was no difference in gas exchange and lung volumes between DP1 and C. We found a significant reduction of TL(COsb), TL(COss), KCO parameters as compared with controls in diabetic patients with initial late complications (DP2). Severe diabetic microangiopath (DP3, DP4) associated with significantly decreased TL(CO) and reduction total lung capacity (TLC). Typical features of restrictive pulmonary defects, namely a reduction of TLC and TL(CO) were observed predominantly in patients with diabetic nephropathy of stage IV-V. There was no evidence of air flow limitation in any of diabetics studied. CONCLUSION: Diabetic process caused decreased pulmonary gas exchange and reduction of lung volumes. These gasometric and spirometric changes indicated some coexistence with late diabetic complications.

[Assessment of main metabolic substrates utilization during aerobic phase of physical exercises in patients with first diagnosed type 1 diabetes mellitus and in healthy persons].

The purpose of the research was to study influence of first diagnosed type 1 diabetes mellitus (FDDM-1), including metabolic consequences of diabetic ketoacidosis, on utilization of main nutritious substrates under conditions of aerobic exercise. 48 patients with FDDM-1 (15females and 33 males) and 36 healthy volunteers, composing the control group, had a protocol of bicycle ergometry test with slowly growing load. Patients with FDDM-1 were divided into 2 subgroups in line with clinical characteristic of endocrinopathy debut. Subgroup 1 consisted of 15 patients, who had diabetic precoma, subgroup 2 was composed of 33 patients who did not have diabetic ketoacidosis in onset of disease. Aerobic load in patients with FDDM-1 was realized in stable condition of the main disease subcompensation, and in 1 month under condition of FDDM-1 compensation. Lipid and carbohydrate consumption percentage was estimated by the method of indirect colorimetry. Patients with FDDM-1 in stage of subcompensation did not have metabolism transformation with dominating consumption of lipids, which was noticed in healthy persons. When increase intensity of physical exercise, the reliably higher rate of carbohydrate sources consumption for supply of muscular contractions was noticed in patients with FDDM-1, especially in subgroup 2. After FDDM-1 compensation the structure of metabolic substrates consumption in warm-up period in both subgroups of patients with FDDM-1 did not have reliable differences in comparison with control group, but all further levels of aerobic exercise were characterized by significant increase of carbohydrate sources oxidation in comparison with such oxidation in healthy persons. Patients with FDDM-1 had decreased muscular tissue ability to utilize lipids in the aerobic stage of physical exercise, which can cause decrease of tolerance to physical work as a result of disorder lipid and carbohydrate participation in motion activity.

[Physical work ability in patients with type 1 diabetes].

Physical work ability was assessed in 128 patients with a long duration of type 1 diabetes mellitus and 36 practically healthy people by K. Wasserman stepwise standard loading test with permanent monitoring of the load, oxygen consumption, and respiratory coefficient. Oxygen consumption was calculated per 1 kg body mass, and anaerobic metabolism threshold was determined. The patients were divided into three groups: Group 1 consisting of patients without clinically detectable microangiopathic complications, Group 2 with initial, and Group 3 with advanced manifestations of late diabetic syndrome. Average levels of maximum oxygen consumption, the achieved load, oxygen consumption per 1 kg body mass at the peak of physical load, and anaerobic threshold were significantly lower in all the three groups compared to controls. Respiratory coefficient at the peak of loading testing was significantly higher in diabetic patients than in controls. The study demonstrated that microangiopathic alterations significantly reduced physical work ability in patients with type 1 diabetes mellitus. Nevertheless, this study demonstrated low physical exercise tolerance in a large part of young diabetics without clinically detectable microvascular complications of endocrinopathy. A decrease in maximum oxygen consumption in these patients may be of multi-factor nature and may be a result of both central (hemodynamics) and peripheral (microcirculation, muscular metabolism) mechanisms limiting the function of the gas transport system.

[The condition of external respiratory mechanics in patients with type 1 diabetes].

External respiratory mechanics was studied in 141 patients with type 1 diabetes mellitus (DM1) and 36 healthy controls using computed analysis of flow-volume loop and total body plethysmography. The DM1 patients were divided into 4 groups: group 1 consisted of patients without clinical signs of microangiopathic complications; groups 2 and 3 consisted of patients with initial and advanced manifestations of late diabetic syndrome (LDS), respectively; group 4 consisted of patients suffering from severe endocrinopathy with end-stage chronic renal failure. The velocity and volume parameters in groups 1 and 2 did not differ significantly from those in the controls. Significant reduction in the vital capacity, forced expiratory volume in one second, and total lung capacity was noted in patients with advanced LDS and uremia. Forced expiratory volume in one second decreased in proportion to reduction in lung vital capacity, which did not cause Tiffno index to leave the reference range. The authors came to the conclusion that DMI causes restrictive ventilatory defect, associated with advanced clinical manifestations of microangiopathic alterations.

[Serum lipoproteins in different types of obesity in lipid loading challenge]. / Lipoproteidy syvorotki krovi pri razlichnykh tipakh ozhireniia v usloviiakh zhirovoi nagruzki.

The impact of food fat load on plasmic lipid transport system (LTS) was studied in persons with abdominal and gluteofemoral obesity by the standard fat test proposed by J. Patsch. The lipoprotein spectrum in abdominally obese patients was characterized by high atherogenicity of lipoprotein spectrum on an empty stomach aggravating under fat intake: prolongation of postprandial lipemia up to 6 hours with growing apoB and apoB/A1. Patients with gluteofemoral obesity differed from normal weight persons only by higher fasting values of triglycerides. They showed no atherogenic trend in changes in response to food fat.